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Q: Visions & the Full Moon
Dr. Phelps:
My husband, 51 years, has been diagnosed by a Neuropsychologist with Bipolar I
and Dementia (unknown origin). He generally maintains successfully
medicated with Wellbutrin and Gabapentin. However, he has noticed
"hallucinations" of a sort upon attempting to go to sleep which involve gears
turning and interacting (as in a clock) somehow connected, he says, to visions
of planetary systems. These hallucinations became particularly powerful this
year during the full harvest moon, 9-10-03, while we were building our cabin in
the Alaskan bush. He is convinced there is a connection. He also reports a
"physical sensation" that goes with the visions. Please advise as to whether you
have heard of this particular set of symptoms and any research that may have
been done or is ongoing. Though he reports that his symptoms worsen
monthly during the full moon I have only noticed a seasonal (fall) correlation
during our 5 years of marriage. Thanks so much.
Dear Ms. F' --
Well, this is pretty complicated. I'll just throw out some thoughts in somewhat
random order:
1. Wellbutrin and Gabapentin for bipolar disorder.
Well, this is not standard treatment, to put it mildly. The reason I say that
bluntly is that it seems to me that his "dementia" might at least be exacerbated
by either of these medications, if not caused thereby (e.g. if the "dementia"
clearly preceded each of them; if not, they are obvious candidates for
examination as to the basis of the "dementia"). This line of thought is further
warranted by the "hallucinations" story, regardless of its timing -- i.e. that
this symptom as well warrants some examination as to whether these medications
might be "causing" it somehow, or at least exacerbating it. (Background, if
needed: Wellbutrin is an antidepressant, and all antidepressants can make
bipolar disorder worse, with a few exceptions perhaps like exercise;
Wellbutrin works in part through a neurotransmitter called dopamine, which is
associated with hallucinations in schizophrenia for example; Neurontin acts like
an antidepressant in many cases and is not a
mood
stabilizer).
2. On the timing question: Well, first we note that
you're in Alaska, or were this year when this was so notable. And we also note
that this occurred in September, which at Alaskan latitudes (even right here in
mid-Oregon!) exposes a person to a pretty dramatic shift downward in the amount
of light exposure one gets per day. This shift, or something about September,
is well known amongst my colleagues as a time when we'll see a lot of people
with bipolar disorder get worse. Then, on top of this we add substantial light
exposure (the Moon, in this case, while out there in a setting with little other
light at that time). And, the light is at night. We know that light
exposure can clearly affect the circadian rhythms that clearly are associated
with bipolar disorder (e.g. this essay on
biological clocks
and bipolar disorder).
Adding all this up I'd say that perhaps there is indeed
something about the moon in his case. Since women's menstrual cycles, which
clearly affect bipolar disorder, are often linked to the lunar cycle, there's a
relationship in women along these lines but we can't invoke that one in his
case, now, can we.
Finally, I suppose we could wonder if there isn't
something about this unknown "dementia" -- at 51? -- that is interacting with
the moonlight; can't rule that out, since we don't know what we're dealing
with! I guess my point there is that there's something that strikes me as
really fishy about the idea of "dementia" at 51, which is early even in familial
early-onset Alzheimers, but in that case you'd have a family history of that to
go on. So I'd keep my attention on the possibility that somehow the "dementia"
and the bipolar disorder are related (note the implication: since he's not on
standard treatment for bipolar disorder, is it possible the "dementia" could be
addressed by such a standard approach?) (e.g. as outlined on my
education website
(where I don't make any money, so your visit there, if I prompt you to it, is of
no advantage to me, just wondering out loud here; have a look at the section on
treatment, which applies to BP I as well as to BPII....).
I'd be
interested in hearing from
you if you ever learn anything more about any aspect of this, e.g write me
in a year and tell me "remember the Alaska guy with the moon reaction; here's
what's happened since...". Good luck with that. Don't let me get your hopes
all up and ruin your current relationship with his doctor, now; just think
about this and perhaps
cautiously
introduce some of these ideas if you think that's warranted.
Dr. Phelps
Published December, 2003
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